© 2007 European Society of Cardiology
Body mass index, prognosis and mode of death in chronic heart failure: Results from the Valsartan Heart Failure Trial
a Department of Biomedical and Surgical Sciences, Section of Cardiology, University of Verona Piazzale Stefani, 1-Verona, Italy
b ANMCO Research Center Florence, Italy
c Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche "Mario Negri" Milan, Italy
d Szt. Janos Korhaz es Rendelointezet 3rd Department of Internal Medicine, Budapest, Hungary
e Hospital General Universitari Vall D'Hebron, Department of Cardiology Barcelona, Spain
f Division of Cardiology, University of Minneapolis Minneapolis, USA
* Corresponding author. Tel.: +39 055 5001703; fax: +39 055 583400. E-mail address: centro_studi{at}anmco.it
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Abstract |
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Aims: To assess the relationship between body mass index (BMI), mortality and mode of death in chronic heart failure (CHF) patients; to define the shape of the relationship between BMI and mortality.
Methods and results: We performed a post-hoc analysis of 5010 patients from the Valsartan Heart Failure Trial. The end-points of the study were all-cause and cardiovascular mortality. Mortality rate was 27.2% in underweight patients (BMI<22 kg/m2), 21.7% in normal weight patients (BMI 22–24.9 kg/m2), 17.9% in overweight patients (BMI 25–29.9 kg/m2) and 16.5% in obese patients (BMI>30 kg/m2) (p<0.0001). The rates of non-cardiovascular death did not differ among groups. The risk of death due to progressive heart failure was 3.4-fold higher in the underweight than in the obese patients (p<0.0001). Normal weight, overweight and obese patients had lower risk of death as compared with underweight patients (p=0.019, HR 0.76, 95% CI 0.61–0.96; p=0.0005, HR 0.68, 95% CI 0.55–0.84; p=0.003, HR 0.67, 95% CI 0.52–0.88, respectively) independently of symptoms, ventricular function, beta-blocker use, C-reactive protein and brain natriuretic peptide levels.
Conclusions: In CHF patients a higher BMI is associated with a better prognosis independently of other clinical variables. The relationship between mortality and BMI is monotonically decreasing.
Key Words: Heart failure • Body mass index • Prognosis
Received April 13, 2006; Revised July 31, 2006; Accepted October 18, 2006
Financial support: This study was supported by a grant from Novartis Pharma, Basel, Switzerland. Drs. Latini, Maggioni and Anand have received honoraria for presentations; Dr. Cohn received research support through consultation arrangements.
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